VP Risk Adjustment San Antonio Texas

UnitedHealth Group
November 4, 2020
San Antonio, TX
Job Type


Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Vice President (VP) of Risk Adjustment, reporting to the Senior VP, serves as a key leader responsible for driving success, improvement and innovation while implementing activities in support of Enterprise and Risk Adjustment strategic priorities. The VP is responsible for strategic leadership, direction and operational support as well as execution of risk adjustment activities for the WellMed enterprise, activities enterprise activities in all markets in which we conduct business as well as support to care delivery organizations utilizing WellMed’s platforms. The VP will provide strategic leadership and oversight of program goals that drive Risk Adjustment Factor (RAF) accuracy, onboarding services as well as overseeing and driving improvement in the submission activities for the centralized services. This leader provides leadership and engagement to ensure the appropriate integration of activities into strategic direction and operations, as well as the mission and values of the company while complying with legal and regulatory requirements. 

Primary Responsibilities:
  • Provide long-range planning and oversight of DataRAP operations
  • Facilitate risk adjustment portion at the Quality and Risk Adjustment (RA) and Contracted Provider Results (CPR) Best Year Yet (BYY) meetings to ensure physician and business leaders understanding and to ensure implementation of strategy at local and regional level
  • Develop strong partnership with regional dyads to execute on enterprise strategy and objectives within their respective markets
  • Lead the short and long term planning process and drive prioritization to meet the enterprise financial performance goals
  • Work with Regional Leadership to develop and implement best practices and utilization of standard process/tools across WellMed contracted and employed providers
  • Ensure implementation of standardized risk adjustment reporting across the enterprise and for those CDOs utilizing DataRAP
  • Ensure application of clinical algorithms within attestation process to enhance ability of providers to assess and document the complete health status of members
  • Identify operational issues/barriers and provide recommendations to team and market leaders to increase efficiency and maximize results
  • Coordinate education for all markets including providers and employees to ensure compliance with corporate risk adjustment processes
  • Plan for and implement a structure that meets operational needs through continued growth
  • Develops and governs the annual budget for department and implements plans to achieve budgetary goals
  • Develop and execute communication to internal and external stakeholders related to clinical documentation strategies and implementation plans

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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